title: Testing the effect of specific orders to provide oral liquid nutritional supplements to nursing home residents: a quality improvement project.
abstract: OBJECTIVE
  To improve nursing home (NH) staff delivery of oral liquid nutritional supplements between meals to residents with a history of weight loss.
  
  
  METHODS
  Pre-Post intervention study.
  
  
  METHODS
  Two skilled nursing homes.
  
  
  METHODS
  Eighteen long term care residents.
  
  
  METHODS
  At baseline all participants had a non-specific physician's order to receive a nutritional supplement. The intervention consisted of specifying the physician's order as follows: "Give 4 oz high protein supplement at 10 am, 2 pm, and 7 pm".
  
  
  METHODS
  Research staff conducted direct observations for two days during and between meals for a total of 4 days, or 12 possible observation periods per participant before and one week following the intervention. Research staff documented NH staff delivery of snacks (including high protein supplements) and amount consumed (fluid ounces) for the high protein supplements using a standardized protocol during each observation period.
  
  
  RESULTS
  Before the specific order was written participants were offered any type of snack an average of 1.82 times per day and a high protein supplement 0.59 times per day. After the specific order was written participants were offered any type of snack an average of 1.59 times per day and a high protein supplement 0.91 times per day. There were no statistically significant differences in the average number of times snacks or supplements were offered before and after the specific order was written. The proportion of snacks offered that were high protein supplements did increase after the specific order was written (p<0.001). When a high protein supplement was provided, most residents consumed 100% of it.
  
  
  CONCLUSIONS
  Oral liquid nutritional supplements were not provided consistent with orders in NH practice. The specificity of the order related to type of supplement and time of delivery did not influence when and how often supplements are provided to residents but it did influence the type of nutritional supplement offered.
authors.affiliation: University of California, Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Geriatrics, Los Angeles, CA 90095-1687, USA. ewhiteman@mednet.ucla.edu
authors.forename: E
authors.initials: E
authors.lastname: Whiteman
authors.forename: K
authors.initials: K
authors.lastname: Ward
authors.forename: S F
authors.initials: SF
authors.lastname: Simmons
authors.forename: C A
authors.initials: CA
authors.lastname: Sarkisian
authors.forename: A A
authors.initials: AA
authors.lastname: Moore
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D004044:Dietary Proteins / Q000008:administration & dosage*; D019587:Dietary Supplements / Q000706:statistics & numerical data; D005260:Female; D005526:Food, Formulated / Q000592:standards*; D019983:Guideline Adherence; D006707:Homes for the Aged / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009732:Nursing Care; D009735:Nursing Homes / Q000592:standards; D009740:Nursing Staff; D044623:Nutrition Therapy / Q000451:nursing*; D015431:Weight Loss; D000078329:Workforce
chemical_list: D004044:Dietary Proteins